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Are antihistamines still used during omalizumab treatment for chronic spontaneous urticaria? Volume 32, issue 5, September-October 2022

Authors
1 Department of Dermatology, Hospital Universitari Sagrat Cor, Barcelona,
2 Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona,
3 Allergy Section, Department of Internal Medicine. Hospital Vall d’Hebron, Barcelona, ARADyAL research network, Instituto de Salud Carlos III (ISCIII),
4 Allergy Section, Department of Pneumology and Allergy. Hospital Clínic, Barcelona,
5 Allergy Section, Department of Internal Medicine, Hospital de Bellvitge, l’Hospitalet de Llobregat, Barcelona,
6 Department of Dermatology, Hospital de Bellvitge, l’Hospitalet de Llobregat, Barcelona,
7 Department of Allergology, Hospital Germans Trias i Pujol, Badalona, Barcelona,
8 Department of Dermatology, Hospital Germans Trias i Pujol, Badalona, Barcelona,
9 Department of Dermatology. Hospital d’Igualada-Consorci Sanitari de l’Anoia, Barcelona,
10 Department of Dermatology, Hospital Arnau de Vilanova, Lleida,
11 Department of Dermatology, Consorci Sanitari Alt Penedès-Garraf,
12 Department of Dermatology, Hospital Universtari Parc Taulí, Sabadell, Barcelona,
13 Department of Allergology, Hospital Universitari Santa Maria, Lleida,
14 Department of Dermatology, Consorci Alt Penedès-Garraf, Vilanova i la Geltrú, Barcelona,
15 Department of Dermatology, Hospital Clínic, Barcelona,
16 Department of Clinical Epidemiology, Hospital de la Santa Creu i Sant Pau, Barcelona. CIBER Epidemiología y Salud Pública (CIBERESP),
17 Department of Dermatology, Hospital del Mar, IMIM, Universitat Autònoma. Barcelona, Spain
Reprints: Gemma Melé-Ninot

Background

The guidelines for the treatment of chronic spontaneous urticaria (CSU) recommend adding omalizumab to the treatment of patients with uncontrolled disease despite four-fold doses of second-generation antihistamines (AH). On the contrary, some studies revealed that omalizumab was effective without concomitant AH and several authors suggest tapering off AH when CSU is controlled with omalizumab.

Objectives

The aim of our study was to evaluate the use of AH during treatment with omalizumab in patients with CSU in real clinical practice.

Materials & Methods

This was a multicentre cross-sectional and observational study conducted by the Catalan and Balearic Chronic Urticaria Network (XUrCB) based on a cohort of 298 CSU patients treated with omalizumab.

Results

In total, 23.5% of our patients decided themselves to stop taking AH during omalizumab treatment. The ratio of patients with CSU without concomitant inducible urticaria and the percentage of patients with a good response to omalizumab (UAS7≤6 and/or UCT ≥12) were higher in those who stopped taking AH.

Conclusion

More studies are required to identify the phenotypic characteristics of patients responding to omalizumab as monotherapy in order to avoid overtreating with AH. Our study suggests that patients with CSU without concomitant inducible urticaria and those who achieve a good response to omalizumab tend to be controlled by omalizumab without AH. In order to establish guidelines on how to stop AH, further evidenced-based studies are required.